A NEW care programme that delivers rounded support to some of the most unwell people in Sunderland has ensured that a pensioner and her beloved parrot can enjoy a happy, independent life together, despite her health problems.

83-year-old Isabella Howden, who lives in Hendon, has been supported by All Together Better Sunderland – a programme that is designed to bring together health and social care professionals to deliver care that wraps around those who need it most.

Having been diagnosed with dementia a little over two years ago, and living with a range of other health concerns including COPD which causes her to suffer from severe breathlessness, Isabella is now supported by a ‘community integrated team’ – part of the All Together Better programme – meaning she is now able to enjoy an independent life with her beloved pet, Milo, an Eclectus parrot she has owned for four years, by her side.

The new programme, which sees health professionals and social care workers come together to agree care packages that support the health, social and emotional needs of the city’s most vulnerable – usually older people with a number of complex medical conditions – means that people are given care that is designed to keep them independent, delivered to them at home, where they are most comfortable.

Isabella was supported by her community integrated team with a move to a new housing scheme designed to support her needs, as well as having the aid of medical professionals to better manage her health needs at home. One member of the team that supports Isabella is social worker Dana Davy, who spent time getting to know her and understanding the things that mattered to Isabella most.

Dana said: “Isabella’s condition means that she can become very anxious, and palpitations – brought about by that anxiety – meant that she was calling 111 between ten and 15 times a day to seek medical support. And though, for the most part, her condition did not require emergency medical attention, the pressure the calls were putting on NHS resources meant it made sense to manage her needs more closely and holistically, working in partnership with health care professionals who were assisting Isabella separately. That’s what All Together Better aims to do. Deliver joined up care that meets all of the needs of the person, avoiding unnecessary hospitalisation or urgent medical care.”

Isabella’s story is a classic example of how, by bringing together health and social care, we can provide support that genuinely meets people’s needs…

It was felt that a supported environment was best for Isabella – something she was keen on if she could keep her feathered friend with her – and Dana, who identified that Isabella’s health care needs were being exacerbated by her living in a home that no longer met her needs, supported with the move as well as working with health colleagues to put in place a care package for Isabella that would take into account her health and emotional needs.

Isabella said: “I did need to move and I needed the extra help that I get now, but, if I could not have had Milo with me, I would not have moved to the flat.

“It sometimes feels like my brain freezes and then I cannot get my breath, and I was scared in my old house by myself. I like to know I have people around when I am unwell. And I like to have Milo with me. He is a comfort to me. It’s nice being somewhere where I can see people through the day, when I get my food dropped off by the carers, or when I look out of the window to the gardens. And I know that if I am unwell, I can be cared for. But more importantly, it is nice to be in a place I can share with my Milo. That means the world to me.”

All Together Better, which is part of a national scheme – called a Vanguard programme – that is testing out new, innovative and more efficient ways of targeting NHS resources, has seen teams from health, social care and support organisations come together to offer more joined up care, that is designed to help people live independently for longer.

Kerry McQuade, head of Vanguard delivery, said: “Isabella’s story is a classic example of how, by bringing together health and social care, we can provide support that genuinely meets people’s needs and prevents people ending up in hospital unnecessarily.

“Taking care out into the community, and allowing people to remain at home and have tailored support delivered to them is not only better for the person, it is better for the NHS. It’s fantastic to see this brought to life so clearly, and to see the positive impact All Together Better is beginning to have on the lives of those who most need our help.”

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